The philosophy that diagnostic dose should be accounted for in radiotherapy planning and treatment is widely recognized, where reduction of imaging dose with ensured adaptive delivery accuracy, deceases the risk of tissue toxicity. However, optimization of a system that embodies such principle has been problematic due to target motion and beam guidance.
What is needed is motion-adaptive image guided radiotherapy for improving the agreement between planned dose pattern and delivery result, to ensure tumor target coverage and reduce likelihood of tissue toxicity.